Research summarized

Suicide rate lower for obese men

Men who are overweight or obese are less likely to commit suicide than other men, says a recent analysis using the Health Professionals Follow-up Study. This supports earlier research findings. The new study looked at data for 46,755 men over a period of 17 years, during which time 131 men died from suicide (from1986 until 2002). Suicide risk was lowered by 11 percent for each 1.0 unit increase of BMI.

The study also found that mental health-related quality of life improved as BMI increased. (Archives of Inter Med, March 12, 2007; Medline Plus NIH, March 13, 2007)

Bariatric surgery can lead to brain disorderWeight loss surgery can lead to a neurological disorder called Wernicke encephalopathy that affects the brain and nervous system causing memory loss and confusion, inability to coordinate movement, vision impairment and other problems. The syndrome is linked to a deficiency of vitamin B1, or thiamine, and occurs most often in patients who have frequent vomiting after surgery, according to a study published in the March issue of Neurology. Most patients developed the disorder between 4 and 12 weeks after the surgery, but some occurred as early as 2 weeks following surgery.

“The number of people getting this surgery has risen dramatically, and I was seeing a lot of these neurological problems emerging after surgery,” said Sonal Singh, lead author of the study. “What was surprising is that some of these cases occurred among people who were taking their vitamins.” (Dunham W. Neurological condition linked to obesity surgery. Reuters: Washington 3/12/07; Singh S. Neurology 3/13/07.)

Older women seek help for eating disorders The federal government does not provide eating disorder statistics, but experts say in recent years more women have been seeking help for eating disorders such as anorexia and bulimia in their 30s, 40s 50s and older. For example, in 2003 the Park Nicollet Health Services’ Eating Disorders Institute in Minneapolis treated 43 patients age 38 or older, about 9 percent of patients; however, in the first six months of 2007 the facility has treated nearly 500 patients over 38, about 35 percent of the total. “Those numbers are staggering,” said Carol Tapen, director of operations at the institute.

The Renfrew Center in Philadelphia reports that 20 percent of its patients in 2005 were 30 or older. These women tend to fall into three categories, says Holly Grishkat, director of Renfrew’s outpatient programs. Some have had an active eating disorder for years. Others have been in remission but the disorder resurfaced when triggered by a new stress in life, such as a divorce or loss. Still others, a smaller group, developed the eating disorder later in life. As a result of these increases some treatment centers are creating special programs for more mature patients. (Forliti A. Disorders hit more than just the young. AP: Minneapolis 7/23/07.)

Weight loss market to reach $58 billionThe latest figures from Marketdata, Inc., which analyses ten major segments of the U.S. diet industry, put the current annual total at $58 billion spent on weight-loss products and services. In a 393-page study entitled: “The U.S. Weight Loss & Diet Control Market (9th edition),” Marketdata projects 6 percent annual growth for the total U.S. weight loss market, to $68.7 billion by 2010, followed thereafter by lower overall growth.

The obesity paradoxThe phenomenon of fewer hospital deaths for obese patients with acute heart failure has been called the “obesity paradox,” as obesity is considered a risk factor for developing heart disease and heart failure.

A recent study at the University of California, reported in the January issue of the American Heart Journal, offers new insights. It analyzed data from over 100,000 patient episodes, taken from the Acute Decompensated Heart Failure National Registry of acute heart failure hospitalizations in 263 hospitals in the United States from October 2001 through December 2004.

The study found that during acute hospitalization for heart failure, in-hospital mortality rate was 6.3 percent for underweight, 4.6 percent for healthy weight, 3.4 percent for overweight and 2.4 percent for obese patients. These findings held when adjusted for age, sex, blood urea nitrogen, blood pressure, and additional prognostic factors.

The researchers say that obese patients may have greater metabolic reserves to call upon during an acute heart failure episode and this may lessen their in-hospital mortality risk. They suggest the possibility that nutritional/metabolic support may have therapeutic benefit in specific patients hospitalized with heart failure. ( Fonarow GC, Srikantha P, et al. An obesity paradox in acute heart failure. American Heart J. 153(1):74-81, January 2007)

Obesity is protective in hospital survivalLarger patients survived better than thinner patients in a comprehensive study of adults with acute lung injury who were being treated in intensive care units. The study, conducted by Ohio State University researchers between 1995 and 2001, included 1,488 mechanically ventilated adults with acute lung injury treated in 106 intensive care units at 84 hospitals in the Project IMPACT database.

Both before and after risk-adjustment, the risk of hospital death was highest in a continuous variable for the underweight group, lower for the normal weight group and at its lowest point for the obese and severely obese groups (BMI 35 to 40). After this point risk increased somewhat but remained well below that of the underweight group.

Further, their functional status at hospital discharge was more often impaired in underweight survivors, while obese patients were significantly more likely to return to their previous functional status. (Over half the patients had a body mass index of 25 or above.)

The authors say their findings are consistent with previous reports on the protective effect of obesity for a number of conditions including hospitalized patients, patients with pneumonia, those needing hemodialysis, those with HIV, and those who have undergone heart transplants. Studies suggest increased mortality in low-BMI population subgroups, they report.

“Despite our large sample size, we did not identify increased mortality in the overweight, obese, or severely obese patient groups. In fact, the overweight group showed decreased mortality, and both the overweight and obese groups showed improved functional status at hospital discharge. … It may be that other factors such as nutritional reserve play a beneficial compensatory role in these patients,” say the Ohio authors.

Their findings show no difference by age when patients under and over 65 were analyzed separately, although they note that some writers suggest that obesity may confer a greater risk for younger hospitalized patients. (O’Brien JM, Phillips GD, et al. BMI independently associated with hospital morality in mechanically ventilated adults with acute lung injury. Critical Care Med 2006;34:738-744.)

Breast cancer undertreated in large patientsObese breast cancer patients are twice as likely to get lower than optimal doses of chemotherapy, say researchers at the University of Rochester Medical Center in New York. In checking the records of 764 women treated for breast cancer between 2002 and 2005 they found that 21 percent of obese women received less than 85 percent of the standard dose for their weight, compared with just 10 percent of lean women who were undertreated. The women were treated at 115 randomly selected private oncology practices around the country.

A dose lower than optimal can affect how the breast cancer responds as well as its risk of recurrence, the researchers said. “Sometimes we’re not curing people because they are not getting the full doses that should be standard.”

While some doctors may worry about giving the high dose of chemotherapy calculated according to an obese woman’s height and weight, they report that research has shown obese women given this correct dosage don’t experience any extra problems. (Reuters Health: Washington. 1/19/07; J of Clinical Oncology 1/18/07.)

Arkansas rethinks school BMI reportingThe 2007 Arkansas legislature has voted to cut back on the nation’s first state-mandated measuring and reporting of students’ BMI. Under the 2003 law, part of former Gov. Mike Huckabee’s Healthy Arkansas initiative to curb obesity in children, schools were required to measure and provide BMI statistics annually for all students in all grades from kindergarten through12th grade.

A repeal bill passed the House early this year but was rejected in the Senate. Rep. Keven Anderson who introduced the repeal bill said he had received many objections from parents to the mandate and the way it was carried out. Other lawmakers said they ‘hear all the time’ from parents who are worried about stigmatization from the tests and from school officials who are concerned about the expense and loss of classroom time the screenings require. Other complaints questioned the accuracy of reports and whether the mandate contributes to children’s health. Anderson called the Huckabee measure a drain on school financial resources and a source for stigmatizing overweight students.

He also said he’s skeptical about the quality and value of the information coming from the program, “I won’t say it’s totally worthless, but it’s highly questionable.”

In the compromise decision, only students in certain grades will be measured, with 11 th and 12 th grades exempt, and it will be easier for parents to opt out if they don’t want their children taking part. Schools are required to adhere to privacy protocols such as that only parents receive the results in a letter sent home. (Kellams L. House, Senate settle on BMI bill. Arkansas Democrat-Gazette. 2/22/07; Moritz R, Thompson D. House votes to eliminate BMI. Arkansas News Bureau, Little Rock 1/30/07. )

Kids’ food ads will changeCompanies representing two-thirds of the $900 million spent annually on advertising directed toward children under age 12 have announced they will limit children’s advertising. The announcement by 11 companies came on the eve of a Federal Trade Commission hearing on the topic. Three other companies made such pledges earlier.

While the rules that each company pledges to follow vary, they reflect new commitments about responsible product placement, school-based advertising and Web-based promotions. Seven companies have agreed to stop using licensed characters to promote unhealthy foods in print or online ads. Several are committed to using cartoon characters in promoting healthy foods, such as vegetables. Some will promote only foods and beverages that meet company-set nutrition standards. For instance, General Mills pledges to pull advertisements for Trix cereal but continue to air commercials for Cocoa Puffs, which has one less gram of sugar per serving.

The companies also say they will allow the Council of Better Business Bureaus and the Children’s Advertising Review to audit and report their marketing plans. Companies pledging to follow the new standards include Kellogg’s, Walt Disney, Kraft Foods, McDonald’s, PepsiCo, Cadbury Schweppes, Campbell Soup, Coca-Cola, General Mills, Hershey, Masterfoods and Unilever.

Nevertheless, Federal officials are continuing their investigation into marketing directed at children and say they will question 44 food and drink companies about their advertising tactics. (Food and Beverage Companies Pledge to Rein in Marketing to Children, AP/ New York Times, 7/18/07.)

Life expectancy rises with populationPopulation in the U.S. reached 300 million on Tuesday, Oct. 17, and along with this population increase comes an even more dramatic rise in average life expectancy, now just a few months short of 78.

In 1915 when the U.S. population reached 100 million, the average lifespan was 54 years. When that doubled to 200 million in 1967, life expectancy was around 70.

“Life expectancy worldwide has been rising pretty steadily since 1840, at a rate of about two years per decade,” says Daniel Perry, executive director of the Alliance for Aging Research. “In 1840, the longest-living people in the world were women in Sweden, and they lived an average of 45 years.”

During the first half of the 20 th century revolutionary advances in medicine and public health were responsible for raising the average life expectancy in the U.S. by more than 20 years – from age 47 in 1900 to age 68 in 1950. In 1900 infant mortality, infectious disease, pandemics and war were the big killers, experts say.

The big killers today are chronic diseases of aging like heart disease and cancer. But in the last 25 years, deaths from stroke and heart attacks have dropped by almost 50 percent. Cancer deaths are also declining. Dramatic reductions in infant mortalitly and easier access to emergency care have also helped increase life expectancy.

Some experts on aging say that within 50 years, the average person living in an industrialized nation with good access to health care will live to be at least 100.

“Some people have lived as long as 120 years, so we know that this is possible for our species,” Perry says. “Older people today are able to remain functionally independent much longer than in the past.” There is also some clinical evidence that older people today are happier, healthier, and functioning better than their parents or grandparents. (Boyles S. Americans living longer than ever. WebMD Medical News 10/17/06)

Physical activity helpful in binge eating disorderLevels of physical activity are extremely low for many obese adults who seek treatment for binge eating disorder (BED). A Yale University study of 166 obese adults (121 women and 45 men) with BED highlights the degree to which these patients are inactive. Only 13 percent engaged in recommended levels of activity (30 min/day of moderate activity at least 5 days a week or 20 min/day of vigorous activity at least 3 days a week, CDC-ACSM).Over half (52%) engaged in no sports or recreational activities at all, and 87 percent were considered inactive or insufficiently active. However, lifestyle activity was unrelated to weight, and both structured and unstructured activity were unrelated to behavioral and psychological features of BED. Greater concerns about body shape appearance in women were associated with lower levels of activity.

The researchers cite two studies that show treatment combined with focused walking resulted in significant reductions in both binge eating and weight for obese women with BED. They suggest that adding physical activity interventions to established treatments can be helpful and call for more research to elucidate potential benefits in this patient population. (Hrabosky JI, White MA, et al. Physical activity and its correlates in treatment-seeking obese patients with binge eating disorder. Int J Eat Disord 2007;40:72-76.)

Hunger report from USDAIn the latest report, 11 percent of American households were food insecure at least some of the time during 2005, a decline from 11.9 percent the year before, while 89 percent of households were food secure, meaning that they had access at all times to enough food for an active, healthy life for all household members. The prevalence of very low food security remained unchanged from the previous year at 3.9 percent, or about one-third of the food-insecure households. This means that at times the food intake of some household members is reduced and their normal eating patterns are disrupted. The hunger report, based on data from the December 2005 food security survey, is available from the U.S. Dept of Agriculture. (Nord M, Andrews M, Carlson S. Household Food Security in the US, 2005. USDA, Economic Research Report (ERR-29) 68 pp, Nov. 2006. www.ers.usda.gov/publications/err29)

Gastric surgery riskier for older adultsWeight loss surgery may be riskier than thought, especially for older patients, according to a study that analyzed the risks at one year for the Medicare patients who underwent surgery between 1997 and 2002. Some previous studies found death rates well under 1 percent. But in the study of 16,155 Medicare patients who underwent obesity surgery, more than 5 percent of men and nearly 3 percent of women aged 35 to 44 had died within one year of surgery. Among patients 65 to 74, nearly 13 percent of men and about 6 percent of women died in that time. For patients age 75 and older, half the men and 40 percent of the women died in the first year. Medicare covers obesity surgery if recommended by the physician to treat related conditions such as diabetes and heart problems, and for younger Americans with disabilities. The researchers suggest that obesity surgery may not be right for an older person who has been obese for many years. ( Flum DR, Salem L, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294:1903-1908.)

Former smokers more rigid binge eatersResearch has shown differences between smokers and nonsmokers for eating disorder patients. Studies find that (1) smokers exhibit a general worsening of the eating disorder profile in both anorexia and bulimia nervosa; (2) smoking is more common among individuals who binge eat than who have anorexia nervosa; (3) smoking is associated with increased likelihood of bingeing and vomiting, and greater maturity fears; and (4) female eating disorder patients who smoke report higher levels of body dissatisfaction, drive for thinness, and interoceptive awareness than nonsmoking patients.

A recent study extends many of these differences to former smokers; such differences tend to persist even though they have successfully quit smoking many years before. The study of 91 obese women with clinical binge eating disorder, with 53 classified as never smokers and 38 as former smokers (an average 15- year interval since smoking cessation), found that the former smokers were more likely to endorse specific symptoms of eating pathology – to have rigid dieting strategies, higher levels of dietary restraint, and avoidance of eating. The researchers suggest that binge eating may have replaced smoking as an insufficient coping strategy. The two groups did not differ in age, body mass index, or in frequency of objective and subjective bulimic episodes during the past three months.

The findings indicate that treatment-seeking obese persons with binge eating problems and a smoking history may represent a subset of patients who may benefit from special treatment to address rigid and pathological patterns, say the researchers. They call for further research to investigate whether smokers and nonsmokers respond differently to standard treatment for BED. (White MA, Grilo CM. Symptom severity in obese women with binge eating disorder as a function of smoking history. Int J Eat Disord 2007;40:77-81.)

NIH promotes We Can! programThe National Institutes of Health is showcasing a new city program called “Ways to Enhance Children’s Activity and Nutrition (We Can!),” a local obesity-prevention effort that offers science-based curricula developed to help children and parents adopt healthy lifestyles. The We Can! programs aim to help city and community leaders work locally to improve food choices, increase physical activity and reduce sedentary behavior, such as television viewing. It’s especially aimed at helping children ages 8 to 13.

NIH provides technical assistance and materials, including parent handbooks, posters, videos and an action toolkit. The We Can! Program currently supports 173 community sites in 39 states. Fifteen Fortune 500 companies, including Wal-Mart and Black Entertainment Television, also are involved in implementing We Can! programs. (Kaplan, Atlanta Journal-Constitution, 5/4/07; NIH News Release, 4/25/07)

YRBS reports kids’ weightNationwide, 13.1 percent of U.S. high school students grades 9-12 reported being overweight in the latest Youth Risk Behavior survey (YRBS), conducted during October 2004 – January 2006; 15.7 percent were at risk for becoming overweight. Students with a BMI of the 95 th percentile and above are defined as overweight, or with a BMI of 85 th up to 95 th percentile as at risk.

Overall, the prevalence of overweight was higher among male than female students (16 vs 10 percent), and higher among white and Hispanic males than white and Hispanic females (15.2, 21.3, 8.2, 12.1 percent, respectively). Overall, the prevalence of overweight was higher among black and Hispanic than white students (16, 16.8, and 11.8 percent, respectively); higher among black female than Hispanic female and white female students (16.1, 12.1, and 8.2 percent) and higher among Hispanic male than white male and black male students (21.3, 15.9 and 15.2 percent).

Nationwide, 45.6 percent of students were trying to lose weight – 61.7 percent of females compared with 30 percent of male students. To lose or keep from gaining weight in the 30 days before the survey, 40 percent of all students ate less food, fewer calories or foods low in fat; 60 percent exercised; 12.3 percent fasted for 24 hours or more (17 percent of females compared with 7.6 percent of males); 6.3 percent took diet pills, powders or liquids without a doctor’s advice (highest rate was in white females at 9.2 percent); and 4.5 percent had vomited or taken laxatives (highest for white and Hispanic females at 6.8 percent).

The YRBS is a self-reported survey that monitors six categories of priority health-risk behaviors among high school youth and young adults, and includes general health status, unhealthy dietary behaviors, physical inactivity and the prevalence of overweight. In the US, 71 percent of all deaths among persons age 10 to 24 result from four causes: motor-vehicle crashes, other unintentional injuries, homicide and suicide. The 2005 survey showed that during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes. (Youth Risk Behavior Surveillance – US 2005. Morbidity and Mortality Weekly Report DHHS, CDCP 6/9/06.)

Obesity risks in pregnancyPregnancy is a high-risk time for women to gain excess weight that may be retained after childbirth. A higher weight gain in pregnancy may also contribute to having high birth-weight babies, and perhaps to childhood obesity.

A recent Temple University study analyzed data on 7,660 women from the New Jersey Pregnancy Risk Assessment Monitoring System data to assess these weight-related issues. Eighteen percent of the mothers were obese, 13 percent overweight, 53 percent “normal weight” and 16 percent underweight. About half of the women considered overweight or obese gained more weight than recommended during pregnancy. These two groups were more likely to have a Caesarean section and less likely to breastfeed. Their babies also had an increased chance of high birth weight.

The researchers suggest that mothers be counseled to follow the Institute of Medicine’s recommendations for healthy pregnancy weight gain based on their pre-pregnancy BMI. ( Researchers Call for More Aggressive Weight Control Before, During Pregnancy to Reduce Maternal and Childhood Obesity Risk, United Press International, 7/13/07; Temple University release, 7/14/07; Jain et al., American Journal of Perinatology, May 2007.)